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Scuderi MA, Ribeiro Petito M, Unniappan S, Waldner C, Mehain S, McMillian CJ, Snead EC. Safety and efficacy assessment of a GLP-1 mimetic: insulin glargine combination for treatment of feline diabetes mellitus. Domest Anim Endocrinol 2018; 65:80-89. [PMID: 30015124 DOI: 10.1016/j.domaniend.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023]
Abstract
A commonly used therapeutic strategy for type 2 diabetes mellitus (DM) in humans involves the use of synthetic incretin hormone-based therapies including exenatide, a glucagon-like pepetide-1 hormone agonist. Glucagon-like pepetide-1 agonists can be used alone or as an ancillary therapy with other agents, including insulin and oral antihyperglycemics. Little is known about the role of these therapies for DM in cats. Therefore, the primary objective of this study was to evaluate the safety and efficacy of short-acting exenatide combined with insulin, as compared to placebo and insulin for the treatment of DM in cats. Treatment with exenatide was well tolerated; only 2 cats developed side effects requiring dose reduction. Two cats (25%) went into diabetic remission while receiving exenatide and insulin, whereas remission was not reported during placebo treatment. The average change in the daily exogenous insulin dose was significant (β = -0.56 U/kg, 95% confidence interval, -0.96 to -0.15, P = 0.007), and the dose of insulin administered was lower during exenatide treatment. The average weight loss experienced on exenatide was significantly higher than on placebo (β = 0.65 kg, 95% confidence interval, 0.09-1.21, P = 0.02). There was no significant difference in any of the hormone concentrations evaluated for cats on exenatide vs placebo treatments. Overall, the treatment of diabetic cats with insulin and a fixed dose of exenatide was found to be safe. The weight loss and decreased exogenous insulin requirement experienced with exenatide treatment could be a significant benefit for overweight diabetic cats and warrants further evaluation.
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Affiliation(s)
- M A Scuderi
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada
| | - M Ribeiro Petito
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada
| | - S Unniappan
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada
| | - C Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada
| | - S Mehain
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada
| | - C J McMillian
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada
| | - E C Snead
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Dr, Saskatoon, Canada.
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Gottlieb S, Rand J. Managing feline diabetes: current perspectives. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2018; 9:33-42. [PMID: 30050865 PMCID: PMC6053045 DOI: 10.2147/vmrr.s125619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus is a common endocrine disease in cats. While type 2 diabetes is the most common form seen in cats, other underlying causes may contribute to insulin resistance. Guidelines for diagnosis vary and often do not take into account prediabetic cats. The goals of treatment are to maximize the chance of remission, while minimizing the risks of hypoglycemia. This article presents a further overview of current treatment and monitoring recommendations for diabetic cats.
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Affiliation(s)
- Susan Gottlieb
- The Cat Clinic, Brisbane, QLD, Australia,
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia,
| | - Jacquie Rand
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia,
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3
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Zapata RC, Meachem MD, Cardoso NC, Mehain SO, McMillan CJ, Snead ER, Chelikani PK. Differential circulating concentrations of adipokines, glucagon and adropin in a clinical population of lean, overweight and diabetic cats. BMC Vet Res 2017; 13:85. [PMID: 28376869 PMCID: PMC5379571 DOI: 10.1186/s12917-017-1011-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/29/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Dyslipidemia, dysregulated adipokine secretion and alteration in glucagon and adropin concentrations are important obesity-related factors in the pathophysiology of human Type 2 diabetes; however, their roles in the pathophysiology of feline diabetes mellitus are relatively unknown. Here, we determined the concentrations of circulating leptin, adiponectin, pro-inflammatory cytokines, glucagon, adropin, triglycerides, and cholesterol, in non-diabetic lean and overweight cats and newly diagnosed diabetic cats. Client-owned cats were recruited and assigned into 3 study groups: lean, overweight and diabetic. Fasting blood samples were analyzed in lean, overweight and diabetic cats at baseline and 4 weeks after consumption of high protein/low carbohydrate standardized diet. RESULTS Serum concentrations of triglycerides were greater in diabetics at baseline and were increased in both diabetic and overweight cats at 4 weeks. Plasma leptin concentrations were greater in diabetic and overweight at baseline and 4 weeks, whereas adiponectin was lower in diabetics compared to lean and overweight cats at baseline and 4 weeks. Diabetics had greater baseline plasma glucagon concentrations compared to lean, lower adropin than overweight at 4 weeks, and lower IL-12 concentrations at 4 weeks than baseline. CONCLUSIONS Our results suggest that feline obesity and diabetes mellitus are characterized by hypertriglyceridemia and hyperleptinemia; however, diabetic cats have significantly lower adiponectin and adropin compared to overweight cats. Thus, despite having similar body condition, overweight and diabetic cats have differential circulating concentrations of adiponectin and adropin.
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Affiliation(s)
- Rizaldy C Zapata
- Department of Production Animal Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N4N1, Canada.
| | - Melissa D Meachem
- Department of Veterinary Pathology, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, Canada
| | - Natalia Cavalca Cardoso
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, Canada
| | - Susan O Mehain
- Veterinary Teaching Hospital, College of Veterinary Medicine, Washington State University, 205 Ott Rd, Pullman, WA, 99164-7060, USA
| | - Chantal J McMillan
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada
| | - Elisabeth R Snead
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, Canada
| | - Prasanth K Chelikani
- Department of Production Animal Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
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Nack R, DeClue AE. In cats with newly diagnosed diabetes mellitus, use of a near-euglycemic management paradigm improves remission rate over a traditional paradigm. Vet Q 2014; 34:132-6. [DOI: 10.1080/01652176.2014.924057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schermerhorn T. Normal glucose metabolism in carnivores overlaps with diabetes pathology in non-carnivores. Front Endocrinol (Lausanne) 2013; 4:188. [PMID: 24348462 PMCID: PMC3847661 DOI: 10.3389/fendo.2013.00188] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/19/2013] [Indexed: 12/15/2022] Open
Abstract
Carnivores, such as the dolphin and the domestic cat, have numerous adaptations that befit consumption of diets with high protein and fat content, with little carbohydrate content. Consequently, nutrient metabolism in carnivorous species differs substantially from that of non-carnivores. Important metabolic pathways known to differ between carnivores and non-carnivores are implicated in the development of diabetes and insulin resistance in non-carnivores: (1) the hepatic glucokinase (GCK) pathway is absent in healthy carnivores yet GCK deficiency may result in diabetes in rodents and humans, (2) healthy dolphins and cats are prone to periods of fasting hyperglycemia and exhibit insulin resistance, both of which are risk factors for diabetes in non-carnivores. Similarly, carnivores develop naturally occurring diseases such as hemochromatosis, fatty liver, obesity, and diabetes that have strong parallels with the same disorders in humans. Understanding how evolution, environment, diet, and domestication may play a role with nutrient metabolism in the dolphin and cat may also be relevant to human diabetes.
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Affiliation(s)
- Thomas Schermerhorn
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
- *Correspondence: Thomas Schermerhorn, Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, 1800 Denison Avenue, Manhattan, KS 66506-5606, USA e-mail:
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6
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Palm CA, Feldman EC. Oral Hypoglycemics in Cats with Diabetes Mellitus. Vet Clin North Am Small Anim Pract 2013; 43:407-15. [DOI: 10.1016/j.cvsm.2012.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Farrow H, Rand JS, Morton JM, Sunvold G. Postprandial glycaemia in cats fed a moderate carbohydrate meal persists for a median of 12 hours--female cats have higher peak glucose concentrations. J Feline Med Surg 2012; 14:706-15. [PMID: 22653915 DOI: 10.1177/1098612x12449702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The postprandial increase in glucose concentration is typically not considered in selecting diets to manage diabetic and pre-diabetic cats. This study describes increases in glucose and insulin concentrations in 24 clinically healthy, neutered adult cats following one meal (59 kcal/kg) of a moderate carbohydrate diet (25% of energy). Median time to return to baseline after feeding for glucose was 12.2 h (1.8-≥24 h) and for insulin was 12.3 h (1.5-≥24 h). Time to return to baseline for glucose was not different between male (10.2 h) and female (17.2 h) cats. There was evidence female cats had a longer return to baseline for insulin (18.9 h versus 9.8 h) and females had higher (0.9 mmol/l difference) peak glucose than males. This demonstrates that the duration of postprandial glycaemia in cats is markedly longer than in dogs and humans, and should be considered when managing diabetic and pre-diabetic cats.
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Affiliation(s)
- Heidi Farrow
- Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, St Lucia, Brisbane, Australia
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Aptekmann KP, Schwartz DS. A survey of owner attitudes and experiences in managing diabetic dogs. Vet J 2011; 190:e122-e124. [PMID: 21396860 DOI: 10.1016/j.tvjl.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 01/31/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
A survey of the experiences of owners of diabetic dogs was carried out by distributing questionnaires to veterinary clinics in São Paulo, Brazil. A total of 93 dog owners were surveyed over a 4 month period and descriptive statistical analysis, frequency distribution and correlations were performed. In most cases the clinical condition of the dogs had improved following treatment and owners were largely satisfied with veterinary intervention. Injection of neutral protamine hagedorm twice daily was the most commonly prescribed treatment and respondents found this procedure easy to perform, although it did pose some difficulties when the owners were away from their animals. Cost was considered an important factor at the initiation of treatment programs. The information gleaned from this survey, in providing useful insights into the attitudes and experiences of owners of diabetic animals, will contribute to improvements in the treatment and management of such patients.
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Affiliation(s)
- Karina P Aptekmann
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, SP, Brazil.
| | - Denise S Schwartz
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil
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Roomp K, Rand J. Intensive Blood Glucose Control is Safe and Effective in Diabetic Cats Using Home Monitoring and Treatment with Glargine. J Feline Med Surg 2009; 11:668-82. [DOI: 10.1016/j.jfms.2009.04.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2009] [Indexed: 01/01/2023]
Abstract
Human diabetic patients routinely self-adjust their insulin dose using a protocol and home monitoring, and perform equally well or outperform physician directed adjustments. The objective of this study was to report the outcome of home monitoring of diabetic cats by owners using a protocol aimed at achieving euglycaemia, using ultra-low carbohydrate diets (≤10% metabolisable energy) and the insulin analogue glargine for >10 weeks and/or until remission was achieved. Fifty-five cats diagnosed with diabetes mellitus, whose owners joined the online German Diabetes-Katzen Forum, were included. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis ( P<0.001). Only one mild clinical hypoglycaemic episode occurred observed despite tight blood glucose control. In conclusion, intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine.
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Affiliation(s)
- Kirsten Roomp
- Department of Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbrücken, Germany
| | - Jacquie Rand
- Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, QLD 4072, Australia
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DeClue AE, Leverenz EF, Wiedmeyer CE, Bryan ME, Reinero CR. Glucose lowering effects of inhaled insulin in healthy cats. J Feline Med Surg 2008; 10:519-22. [DOI: 10.1016/j.jfms.2008.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2008] [Indexed: 11/25/2022]
Abstract
Inhaled medications have proven effective and well tolerated in cats, and inhaled insulin has been used successfully for the management of diabetes mellitus in humans. Thus, we hypothesize that delivery of aerosolized regular insulin can lower blood glucose in healthy cats. Five adult cats were administered aerosolized 0.9% saline (IS), regular insulin intravenously (IV) 0.5 U/kg, and aerosolized regular insulin 15 U/kg (I15) and 25 U/kg (I25) and blood glucose was evaluated. Mean blood glucose was significantly lower at 15, 30 and 45 min in the I25 and IV groups compared to baseline. Similarly, the IV and I25 groups had a significantly greater maximal percent change in blood glucose than the IS group. Significantly more cats developed severe hypoglycemia (<50 mg/dl; 2.7 mmol/l) in the IV and I25 groups than in the IS group. Results of this study demonstrate that aerosolized insulin can effectively lower blood glucose concentrations in healthy cats.
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Affiliation(s)
- Amy E. DeClue
- Department of Veterinary Medicine and
Surgery, University of Missouri – College of Veterinary Medicine, 900 East Campus Drive,
Columbia, MO 65211, United States
| | - Elizabeth F. Leverenz
- Department of Veterinary Medicine and
Surgery, University of Missouri – College of Veterinary Medicine, 900 East Campus Drive,
Columbia, MO 65211, United States
| | - Charles E. Wiedmeyer
- Department of Veterinary Pathobiology,
University of Missouri – College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO
65211, United States
| | - Margaret E. Bryan
- Department of Statistics, College of
Agricultural, Human and Natural Resource Sciences, Washington State University, PO Box
643144, Pullman, WA 99164, United States
| | - Carol R. Reinero
- Department of Veterinary Medicine and
Surgery, University of Missouri – College of Veterinary Medicine, 900 East Campus Drive,
Columbia, MO 65211, United States
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Wang T, Shankar K, Ronis MJ, Mehendale HM. Mechanisms and outcomes of drug- and toxicant-induced liver toxicity in diabetes. Crit Rev Toxicol 2007; 37:413-59. [PMID: 17612954 DOI: 10.1080/10408440701215100] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increase dincidences of hepatotoxicity have been observed in diabetic patients receiving drug therapies. Neither the mechanisms nor the predisposing factors underlying hepatotoxicity in diabetics are clearly understood. Animal studies designed to examine the mechanisms of diabetes-modulated hepatotoxicity have traditionally focused only on bioactivation/detoxification of drugs and toxicants. It is becoming clear that once injury is initiated, additional events determine the final outcome of liver injury. Foremost among them are two leading mechanisms: first, biochemical mechanisms that lead to progression or regression of injury; and second, whether or not timely and adequate liver tissue repair occurs to mitigate injury and restore liver function. The liver has a remarkable ability to repair and restore its structure and function after physical or chemical-induced damage. The dynamic interaction between biotransformation-based liver injury and compensatory tissue repair plays a pivotal role in determining the ultimate outcome of hepatotoxicity initiated by drugs or toxicants. In this review, mechanisms underlying altered hepatotoxicity in diabetes with emphasis on both altered bioactivation and liver tissue repair are discussed. Animal models of both marked sensitivity (diabetic rats) and equally marked protection (diabetic mice) from drug-induced hepatotoxicity are described. These examples represent a remarkable species difference. Availability of the rodent diabetic models offers a unique opportunity to uncover mechanisms of clinical interest in averting human diabetic sensitivity to drug-induced hepatotoxicities. While the rat diabetic models appear to be suitable, the diabetic mouse models might not be suitable in preclinical testing for potential hepatotoxic effects of drugs or toxicants, because regardless of type 1 or type2 diabetes, mice are resistant to acute drug-or toxicant-induced toxicities.
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Affiliation(s)
- T Wang
- Department of Toxicology, College of Pharmacy, University of Louisiana at Monroe, Monroe, Louisiana 71209, USA
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